Early diagnosis of breast carcinoma]

A case of 'benign tumor' of the liver (hepatocytic hamartoma), in a 24-year-old female is presented. The angiographic aspects are stressed and the radiological disgnosis is discussed in the light of similar observations reported in the recent medical literature.     

Giant fibroadenoma of the breast. Its clinical picture and differential diagnosis. A report of a clinical case

The Schizosaccharomyces pombe genes, nda1 and nda4, are essential for the normal regulation of DNA replication and belong to the MCM gene family. This gene family includes Saccharomyces cerevisiae MCM2, MCM3, MCM5/CDC46 and CDC47, S. pombe nda1, nda4, cdc21 and mis5, and genes encoding human BM28, P1MCM3 and P1.1MCM3 and mouse P1MCM3, most of which are considered to be required for the initiation of DNA replication. We isolated two homologues of the MCM genes, xMCM2 and xCDC46, from a Xenopus laevis cDNA library using the polymerase chain reaction (PCR) method. The predicted amino acid (aa) sequences of xMCM2 and xCDC46 are most similar to those of human BM28 (78% identity) and S. pombe Nda4 (48% identity), respectively. By Western blot analysis using anti-xMCM2 and anti-xCDC46 polyclonal antibodies (Ab) raised against glutathione S-transferase (GST)::xMCM2 or GST::xCDC46 fusion proteins, xMCM2 and xCDC46 were identified as 120- and 95-kDa proteins, respectively. When either xMCM2 or xCDC46 was immunoprecipitated with the specific Ab, the other was also co-precipitated. These results suggest that xMCM2 and xCDC46 physically interact with each other.     

Cytologic diagnosis of signet-ring cell carcinoma of the breast

OBJECTIVE: To examine the cytologic features of signet-ring cell carcinoma (SRCC), defined as carcinoma dominated by signet-ring cells, of the breast and to discuss problems that occur in cytodiagnosis. STUDY DESIGN: Five cases of SRCC of the breast were examined cytopathologically. Signet-ring cells were subclassified into intracytoplasmic lumina (ICL) type and non-ICL type. ICL type had large ICL containing mucin. Non-ICL-type cells had wide, amorphous cytoplasm diffusely dispersed with mucin. RESULTS: In cases 1 and 2, fine needle aspiration biopsy (FNAB) revealed many signet-ring cells (non-ICL type), suggesting SRCC. Histologic diagnoses were ductal SRCC containing many signet-ring cells (non-ICL type). In cases 3 and 4, signet-ring cells (ICL type) were found sporadically among carcinoma cells without signet-ring features. Signet-ring cells were not regarded as the major component of the cells; thus, the cytologic diagnoses were lobular carcinoma, not otherwise specified. Pathologic diagnoses were lobular SRCC. Signet-ring cells were mostly ICL type. In case 5, most carcinoma cells on the smears showed signet-ring features (non-ICL type), suggesting SRCC. The histologic diagnosis was lobular SRCC, and signet-ring cells were mostly non-ICL type. CONCLUSION: Ductal SRCC yielded more cellular smears as compared with lobular SRCC; therefore, cytologic diagnosis was easier in the former.     

Genetic diagnosis and therapy of hereditary breast carcinoma]

Congenital genetic disturbances in the genes BRCA1 and BRCA2 could lead to the forming of mamacarcinoma and ovarian carcinomas. The probability of illness is by an existing gene defect very high, and mostly young women are already affected. A direct anamnestic identification of high risk person with a following proof of gene mutations could help the patient. The way of the clinical-consultation which is recommending the BRCA1-BRCA2-test in reasons for an early recognition diagnosis is at the moment subject in clinical and scientific research.     

Ultrasound diagnosis of the shoulder

Sonography of the shoulder joint is a well-established technique in the hands of the experienced examiner, when using a standardized protocol. It has proved invaluable in assessing pathological soft tissue changes, especially after trauma. The static evaluation of anatomy and dynamic assessment of function are especially helpful in both preoperative staging and postoperative follow-up. The normal anatomy, examination techniques, including our own variations, and pathological conditions are discussed. The findings and various classifications of impingement syndrome, rotator cuff injuries, biceps tendon lesions and inflammatory changes are examined. Review of the major articles in the literature shows excellent correlation with our results, the overall sensitivity in the case of rotator cuff lesions being over 90%. A well-performed ultrasound examination in most cases obviates the need for the more invasive arthroscopy and the more cumbersome and expensive MRI examinations.     

Fine-needle sampling of a case of carcinoma of the breast with neuroendocrine differentiation

Biochemical and pharmacological characterization of small synaptic vesicle (SSV) membrane proteins and genetic studies of yeast secretion mutants led to the identification of an exocytotic fusion complex. The S?llner-Rothman SNARE hypothesis has led to remarkable progresses in the understanding of the molecular mechanisms of neurotransmitter release, endocrine and exocrine cell secretion.     

Psychological aspects of predictive genetic diagnosis in breast and ovarian carcinoma

Mutations on the genes BRCA1 and BRCA2, that predispose women to breast and ovarian cancer were localised in 1990 (Hall et al. 1990, Narod et al. 1991). With the improvement of the test procedures questions concerning the pros and cons of genetic diagnostic are growing in importance, especially because there are only few scientific studies on the social and psychological consequences of this development. In this article the demands to be made on genetic counselling, the present practice of tests employed in Germany and some "typical" problems of the decision and the consequences of the tests are described.     

Ultrasound in the diagnosis of thromboembolism

Nineteen patients with multiple myeloma resistant to standard alkylating agent therapy or to the VAD regimen received carboplatin at a planned daily dose of 100 mg/M2 on four successive days. Two patients erroneously received a four-fold higher drug dose resulting in bone marrow aplasia and death without antitumor effect in one patient with post-mortem examination. No anti-tumor effect was observed among 15 patients evaluable for response (two lacked follow-up examination of tumor markers). Major toxicities were hematologic and included grade > or = III, leukopenia in 9, thrombocytopenia in 6 and anemia in 3 of the 17 evaluable patients. Their median survival was 9 months. These results indicate that carboplatin is inactive in refractory multiple myeloma.     

Self-anchoring and differentiation processes in the minimal group setting.

In-group favoritism in the minimal group setting was hypothesized to be a function of 2 processes: a tendency to base in-group judgments on the self (self-anchoring) and a tendency to assume 1 group to be the opposite of the other (differentiation). In the first 3 experiments, in which the order of rating the self and target group was varied, categorized and uncategorized participants were given trait information about 1 group and were asked to estimate the level of those traits in the other group. In-group judges tended to base group ratings on the self, whereas out-group and uncategorized judges inferred the 2 groups to be opposite of one another. Experiment 4 attempted to directly assess the direction of inference between self and in-group by giving feedback about self or in-group on unfamiliar dimensions and found that participants were more willing to generalize from self to in-group than from in-group to self. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lobular carcinoma of the breast: cytological features supporting the diagnosis of lobular cancer

Lobular carcinomas have a distinct natural history with a better response to endocrine therapy and a higher incidence of local recurrence and are more often bilateral. The cytological diagnosis of lobular carcinoma permits a discriminating therapeutic approach with pre-operative Tamoxifen, more generous resection margins, and assessment of the contralateral breast. The cytological features of lobular cancer however are not well defined and the low cell yield from such neoplasms can result in a high false negative rate. To determine whether we could improve the pre-operative diagnosis, we reviewed the cytological features of 112 lobular carcinomas. They had small uniform sized nuclei with irregular outlines and inconspicuous nucleoli. The degree of dissociation was similar to duct carcinomas and the incidence of inadequate aspirates was no higher. We found no features that confidently diagnosed lobular cancer or its sub-types. However, using a combination of features, typing of lobular cancer on aspirated material is possible and should be attempted.     

Ultrasound prenatal diagnosis of the Nail-Patella syndrome

The Nail-Patella syndrome (NPS) is an autosomal dominant connective-tissue disorder characterized by the absence or hypoplasia of the nails and patella, posterior illiac horns, elbow deformities, congenital nephropathy cervical ribs and eye problems. The presence of the posterior iliac horns is pathognomonic and have been observed in more than 80 per cent of cases. In this report, we present the first case of prenatal diagnosis of NPS by ultrasound. The possible kidney involvement, combined with other, milder, complications make the prenatal diagnosis of this syndrome worthwhile.     

Ultrasound diagnosis of acute cholecystitis

The results of ultrasonographic examination of the gall-bladder in its acute inflammation in 1070 patients are presented. Parallels between the anatomic changes and ultrasound visual picture of the inflamed wall of the gall-bladder were drawn. The analysis of the results of the examination revealed the most typical symptoms of acute cholecystitis and permitted to differentiate it from similar ultrasonographic symptoms in other diseases of the gall-bladder. From all patients who underwent surgical treatment or diagnostic laparoscopy, the diagnosis was confirmed in 97%. The possibilities of the method in a series of patients after the operation and patients with concomitant diseases are limited, in such cases the punction or drainage of the gall-bladder under the ultrasound scan control for diagnostics and treatment is advisable.     

Ultrasound diagnosis of biliary ascariasis

We report a case of ossifying renal tumor of infancy, which presented as a palpable abdominal mass in an otherwise asymptomatic 10-month-old girl. The tumor was partially calcified and occupied the renal pelvis, causing severe hydronephrosis. The differential diagnosis for a patient this age included Wilms tumor, extra-adrenal neuroblastoma, infection, calculus, calcified hematoma and ossifying renal tumor of infancy. The child underwent heminephrectomy and is currently doing well.     

Fine needle aspiration of the breast. A probabilistic approach to diagnosis of carcinoma

European signing policy favours uncontrolled intersections--a trend which is in marked contrast to the U.S.A. policy. European drivers must constantly keep in mind the general rule of priority at cross-roads which requires one to yield to a vehicle coming from the right, if not otherwise indicated. For a European driver, an uncontrolled junction means an obligation to yield to vehicles on the right while for U.S. drivers, adapted to the U.S.A. system with more frequent signing, an intersection unsigned from his direction suggests priority for him, particularly in an urban area. To demonstrate a safety problem which follows, three American subjects, visiting professors without previous experience of driving in Europe, were asked to drive a 1.8 km route six times with an instrumented car in the downtown area of Helsinki. All of them first showed unsafe driving practices at uncontrolled intersections with restricted visibility in comparison to a local control group, but changed their strategy, both in terms of speed control and visual search, after they had been informed of the European rule of crossroad priority. In spite of the same general rule at blind intersections in a similar urban environment, a different signing policy may cause safety problems for American drivers in Europe, and translate into more accidents at non-priority intersections. Varying rules and practices in different jurisdictions call for further efforts in presenting vital information to foreign motorists and striving towards worldwide uniform traffic control.     

Ultrasound diagnosis of metastatic melanoma of the gallbladder

The abdominal ultrasound examinations of 464 patients with malignant melanoma performed over a 3 year period were reviewed. 23 (5.2%) had soft tissue material attached to the gallbladder wall and projecting into the lumen. Four of these were polyps of less than 1 cm which were thought to be benign, while the remaining 19 had abnormalities likely to be metastatic melanoma. Upper abdominal ultrasound examinations are frequently requested for staging purposes in patients with thick high grade malignant melanoma or clinical suspicion of metastases. Ultrasound clearly identifies the gallbladder and biliary tree in the vast majority of patients and is generally regarded as the imaging modality of choice for suspected gallbladder pathology. As autopsy studies have confirmed the incidence of gallbladder metastases from malignant melanoma to be 15-20%, a careful review of the gallbladder is advocated when abdominal ultrasound examinations are performed on patients with malignant melanoma.     

Inflammatory carcinoma of the breast

Eighty-six patients with the clinical features of inflammatory carcinoma of the breast (erythema, peau d'orange, wheals or ridges) were treated with irradiation for potential cure between July 1948 and December 1970. Long protracted irradiation alone with a strong skin reaction offers 50% local control, which is the best rate yet reported. Any surgical procedure beyond biopsy is probably damaging: all patients subjected to mastectomy developed distant metastases and died. Ninety per cent of the patients were dead by five years and only 3 patients remain alive without evidence of disease 7, 10 and 14 years after radiotherapy. Analysis of survival rates, incidence, sites and times of appearance of local recurrences, and distant metastases is presented.     

Tubulolobular carcinoma of the breast

To assess the adequacy of antihypertensive treatment in the French population, a survey was conducted from October 1990 to April 1991 in five French cities during sales exhibitions. A total of 7107 individuals visited the stand of the French National Committee to have their blood pressure (BP) measured. Among them, 1289 were treated hypertensive subjects fully aware of their treatment. The efficacy of antihypertensive treatment was assessed in this population. Among those hypertensive treated subjects 35 to 65 years old, 60% had a BP < 160/95 mm Hg and 27% < 140/90 mm Hg. Among those > 64 years of age, 44% had a BP < 160/90 mm Hg. In 1992, these results were included in a publication by the World Hypertension League. Data obtained with this new and interesting approach were reviewed 4 years later. The approach is inexpensive (the equivalent of US $28,000) and made it possible to directly inform thousands of people, normotensive and hypertensive, about arterial hypertension and antihypertensive drug therapy, as well as risk factors for cardiovascular disease. This kind of approach may be worth a strict evaluation, to assess whether it is really useful in improving high blood pressure control in the population.     

Ultrasound diagnosis of popliteal arterial aneurysms

"B" mode ultrasound scanning is useful in the diagnosis of popliteal arterial aneurysms. It offers advantages over physical examination and arteriography, since these aneurysms are sometimes difficult to palpate and may be partially filled with laminated clot. The technique is noninvasive and without known hazard in this location. "B" mode ultrasound scanning promises to be useful in the diagnosis of aneurysms of other extremity arteries. It has already been useful in confirming the presence of femoral false aneurysms. Greater familiarity with the technique and improvepd technology will result in even greater reliance on ultrasound diagnosis.